The present disclosure generally relates to a specialized clothing device for people who spend long periods of time on support surfaces. The device can be especially useful to people who sit for prolonged periods in a chair and in particular a wheelchair. The device can also be useful to people who lay for extended periods in bed. In addition, the disclosure encompasses methods for custom fabricating and fitting the specialized clothing for users of support surfaces.
When a user has decreased or absent sensation, a particular danger can be the formation of decubitus ulcers (commonly known as “pressure ulcers” or “bedsores”). Decubitus ulcers are lesions that form on parts of the body that are in ongoing contact with objects such as beds or chairs. The symptoms of decubitus ulcers range from skin redness (stage I) to “tunneling ulcers” with necrosis of the skin, fat, muscle and even bone (stage IV). Decubitus ulcers can lead to hospitalization, plastic surgery, and even amputation. Once a patient has had an ulcer with skin scarring, the risk of future ulcers increases.
Wheelchair users can face a truly daunting (and even deadly) challenge in trying to prevent and manage decubitus ulcers. The sitting position of a wheelchair user focuses significant loads on a small area—the buttocks and surrounding areas. Wheelchair users can face a repeating cycle of ulcer formation, hospitalization, surgery, and bed rest. Not only do wheelchair users often sit for prolonged periods, but the physiology of many wheelchair users, such as the elderly, people with spinal cord injuries (SCI), or paraplegics, makes them more prone to ulcer formation. For example, between a third and a half of people with spinal cord injuries—most of whom use wheelchairs—develop ulcers within five years after the injury. Five to seven percent of people with SCI eventually require hospitalization due to decubitus ulcers, and seven to eight percent of those hospitalized eventually die of complications from ulcers. For wheelchair users, the primary regions of the body affected are generally tissue near weightbearing bony structures such as the sacrum, coccyx, ischial tuberosities, and greater trochanters. When “local factors” such as pressure, shear, heat, and moisture rise, the likelihood of ulcer formation increases.
The repeated insult to the body, however, is only part of the affliction. Hospitalization and long-term bed rest can destroy families and social networks and severely hamper work and leisure. Costs incurred because of decubitus ulcers can be dramatic as well. In some cases, a single patient can incur ulcer-related medical costs that go well beyond one million dollars. Indirect costs such as lost productivity increase this monetary burden. More than 2.5 million pressure ulcers are treated each year in the United States. Estimates put United States expenditures on the treatment of decubitus ulcers as high as $11 billion.
Two forms of external loading play a role in the formation of decubitus ulcers: pressure and shear. Pressure acts perpendicular to the skin surface and produces ischemia. Friction forces act parallel (or tangentially) to the skin surface and produce shear strains within the skin and underlying tissue. Although pressure and shear harm skin by separate mechanisms, both can cause ischemia and thereby reduce the vascular supply to tissue. Studies suggest that shear plays a more significant role in causing ulcers in cases of static, non-repetitive loading of human and animal skin.
Many developers of seat cushions have used various techniques to manage pressure to help prevent the formation of decubitus ulcers. Typically, developers have tried to even out pressures across the entire area of the body in contact with the seat cushion. This is sometimes described as “floatation.” Many efforts to control peak pressure involve foam materials that can undesirably accelerate ulcer formation by impeding heat dissipation and moisture evaporation.
The purpose of the devices and methods of the present disclosure is to overcome the shortcomings and limitations in the prior art.